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Review Article

Emergence of diabetes education and capacity‑building


programs for primary care physicians in India
Rakesh Mehra1, Shivangi Vats1, Rahul Kumar1, Haresh R. Chandwani1,
Sandeep Bhalla1, Pushkar Kumar1, Viswanathan Mohan2
1
Training Division, Public Health Foundation of India, New Delhi, India, 2Dr. Mohan’s Diabetes Specialities Centre, Chennai,
Tamil Nadu, India

A bstract
Diabetes is one of the leading causes of death globally. India is home to the second‑largest population suffering from diabetes.
This underscores the need to build capacity of primary care physicians (PCPs) for better disease management. This narrative review
article aims to describe the emergence of diabetes education and capacity‑building programs for PCPs and its current situation in
India. The review highlighted that major emphasis on diabetes was given only when the WHO estimated that morbidity and mortality
due to diabetes would increase to 35% in India. As a result, National Diabetes Control Program was launched in 1987. Yet, very
little attention was paid to diabetology in under‑graduation. In the last decade, few public and private institutions have developed
diabetes related capacity‑building programs for PCPs independently or in collaborations. These programs include 16 fellowships, 4
diplomas, 12 certificate programs, and 6 other diabetes training programs, which have their own pros and cons. As medical science
is changing rapidly, PCPs need to upgrade their skills and knowledge regularly to manage NCDs such as diabetes more effectively
and efficiently. This can be possible only if scientific, evidence‑based, and quality‑oriented capacity‑building programs are provided
to the healthcare workforce.

Keywords: Capacity building, Diabetes, education, primary care physicians

Introduction According to International Diabetes Federation (IDF), India


is home to 77.0 million people suffering from diabetes and
Diabetes was earlier considered as a disease of the affluent, older projections indicate that the number will increase to 134.2 million
age group, and urban population.[1,2] However, the scenario has by 2045.[6] Additionally, type 1 diabetes among children and
changed in the last few decades as the disorder is moving to the adolescents is the highest in India (171,300) and gestational
poorer section of the society, youth and children; and to the rural diabetes mellitus is also on the rise among Indian women.[6] Being
population, resulting in premature mortality.[3] Diabetes is one a lifelong and burgeoning health problem, diabetes imposes a
of the leading causes of death, with a global prevalence of 8.5% huge socioeconomic burden on individuals, society, and the
among the adult population.[3] The number of people living with country as a whole.[7]
diabetes has increased fourfold in the last three decades[4] as the
disease spread to low‑ and middle‑income countries.[5] India, which accounts for 87.9% of adults with diabetes in the
region, spent USD 92 per person in 2019.[6] According to the
Address for correspondence: Dr. Rakesh Mehra,
World Health Organization diabetes country‑specific profiles,
Plot No 47, Sector 44, Institutional Area, Gurugram,
Haryana ‑ 122 002, India. being the world’s diabetes capital, India has already developed
E‑mail: rakeshmehra13@gmail.com national guidelines along with operational strategies and action
Received: 09‑04‑2021 Revised: 05‑07‑2021
Accepted: 30‑07‑2021 Published: 10-03-2022 This is an open access journal, and articles are distributed under the terms of the Creative
Commons Attribution‑NonCommercial‑ShareAlike 4.0 License, which allows others to
remix, tweak, and build upon the work non‑commercially, as long as appropriate credit is
Access this article online given and the new creations are licensed under the identical terms.
Quick Response Code:
Website:
For reprints contact: WKHLRPMedknow_reprints@wolterskluwer.com
www.jfmpc.com

How to cite this article: Mehra R, Vats S, Kumar R, Chandwani HR, Bhalla S,
DOI: Kumar P, et al. Emergence of diabetes education and capacity‑building
10.4103/jfmpc.jfmpc_669_21 programs for primary care physicians in India. J Family Med Prim Care
2022;11:839-46.

© 2022 Journal of Family Medicine and Primary Care | Published by Wolters Kluwer ‑ Medknow 839
Mehra, et al.: Emergence of diabetes education India

plan for evidence‑based diabetes management.[8] However, not put any effort to start refresher courses for physicians. Though
the existing status of diabetes care quality services is far from certain universities and colleges provided specialization (in
satisfactory level in both urban as well as in rural areas.[9‑11] anatomy, physiology, bacteriology, ophthalmology, orthopedics,
psychological medicine, obstetrics and gynecology, radiology,
Moreover, the quality care of diabetes depends on the knowledge, dermatology, pediatrics, tuberculosis, oto‑rhino‑laryngology,
expertise, attitude, and practice of health care professionals.[12] anesthesia, and venereology), diabetes was not in focus at that
In India, majority of initial diagnosis is made by primary care time.[24]
physicians (PCPs) due to uneven distribution of specialists,
where over 80% of whom practice in urban areas while 72% Diabetes Education in Post‑independence Era
of the population lives in rural areas.[13] On the other hand, the
quality of care provided by PCPs remains suboptimal because Post‑independence, the planning commission had the
of a lack of knowledge and facilities to screen for diabetes and responsibility of development, execution, and monitoring of
its complications.[10] This underscores the need to build capacity all the developmental plans, including the healthcare delivery
of PCPs for better disease management.[14] system in the country. In the initial five‑year plans, the priority
areas were population control, maternal and child health, and
Capacity building is the process by which organizations change communicable diseases in the health sector. Re‑orientation of
and improve how individuals within an organization develop medical education was initiated in the sixth plan but the focus
and retain the competencies (knowledge, skills, and attitudes) was on rural health. The noncommunicable diseases (cancer,
needed to carry out their duties at least competently and coronary heart diseases, hypertension, diabetes and traffic, and
ideally beyond the minimum standard.[15] Diabetes education other accidents) were considered as the emerging health problems
and capacity‑building programs are essential for handling the for the first time only in the seventh plan. Hence, development of
growing burden of diabetes in resource constraint countries.[16‑18] need‑based, problem‑centered, and community‑oriented medical
Therefore, this narrative review article aims to describe the training and education for doctors and paramedical personnel
emergence of diabetes education and capacity‑building programs for the prevention and control of NCD was stressed. As a result,
for PCPs and its current situation in India. National Diabetes Control Program was launched in 1987 as a
central sector health program in the districts of Salem and South
Diabetes in India Arcot in Tamil Nadu, and Jammu and Kashmir, on a pilot basis,
and learning resource materials were developed for the training
Diabetes, which has now emerged as an epidemic, is a of nurses and primary health care workers.[25]
well‑described disease in Ayurveda.[19] The estimation of the
extent of diabetes in ancient India was impossible due to the In subsequent five‑year plans, policymakers gave more
lack of epidemiological records at that time.[20] However, the first importance to NCDs as the WHO estimates showed that
epidemiological study recorded in India was by Chakravarthy A., morbidity and mortality due to communicable diseases will
who assessed and documented the prevalence of glycosuria in a decrease by 15% whereas noncommunicable diseases would
hospital‑based study in Kolkata in 1938.[21] increase by 18% and that for diabetes by 35%. This resulted in the
development of an integrated National Program for Prevention
Indian Council of Medical Research conducted the first national and Control of Cancer, Diabetes, Cardiovascular Diseases,
level, multicentric study to assess the prevalence of diabetes in and Stroke (NCPCDCS) through improving infrastructure,
urban (2%–3%) and rural (1%–1.5%) parts of the country during up‑gradation of health care providers’ skills, and creation of an
1972–75.[22] Thereafter, many studies were undertaken by various epidemiological database of noncommunicable diseases. In this
researchers to estimate the prevalence and incidence of diabetes integrated program, priority was given to cancer, cardiovascular
to identify the various risk factors associated with diabetes. diseases, stroke, and mental health.[26]
These studies range from small‑city surveys to metacentric
large‑scale surveys, case‑control studies, cross‑sectional studies Diabetes Education in National Health
and various surveys covering different geographical areas.[23] Policies
Diabetes Education in Pre‑independence Era In 1983, the first national health policy came into existence in
response to the Alma Ata declaration to achieve “Health for All”
Bhore Committee laid the foundation of health care services by 2000. Nutrition, prevention of food adulteration, maintenance
in India before independence. In 1946, the committee reported of quality of drugs, water supply and sanitation, environment
that 19 medical colleges with an annual intake of 1200 students protection, immunization program, maternal and child health
were not sufficient to tackle the healthcare needs of 400 million services, family planning, communicable diseases, school health
people. The facilities for post‑graduation (MD, MS, and diploma) program, and occupational health services were given priority
in different medical colleges were few and there was no governing in the national health policy. Public health educational programs
body to coordinate and foster post‑graduate education in the also focused on nutrition, family planning, and maternal and
then‑existing universities. Also, governments and universities did child health.[27]

Journal of Family Medicine and Primary Care 840 Volume 11 : Issue 3 : March 2022
Mehra, et al.: Emergence of diabetes education India

In the next twenty years, lifestyle disorders and noncommunicable seventh plan was to develop an appropriate model for care and
diseases such as diabetes, cardiovascular diseases cancer, and control of diabetes mellitus at the district level. The objectives
others increased due to rapid epidemiological transition.[22] This of the program were 1) prevention of diabetes through
compelled the policymakers to review policies and assess the identification of high‑risk subjects and early intervention in
current health needs of the population. As a result, the second the form of health education; 2) early diagnosis of disease and
national health policy was formulated in 2002. The main objective appropriate treatment morbidity and mortality with reference to
of the policy was to provide an equitable and acceptable standard high‑risk group; 3) prevention of acute and chronic metabolic,
of good health via establishing new infrastructure in deficient cardiovascular, renal, and ocular complication of the disease;
areas and upgrading of the existing infrastructure, involvement 4) provision of equal opportunity for physical attainment
of the private sector, and decentralization of the public health and scholastic achievement for the diabetic patients; and 5)
system. A need‑based skill‑oriented syllabus with more significant rehabilitation of those partially or totally handicapped diabetes
component of practical training and periodic skills up‑gradation people. However, due to shortage of funds, this program could
of working health professionals through a system of continuing not be expanded further in subsequent years.[31]
medical education was recommended. School health program,
IEC activities for mass education, worksite wellness programs, On the other hand, due to rapidly increasing NCD burden
strengthening of medical colleges, and integrated NCD clinics and recommendations of National Health Policy 2002 for the
in medical colleges and district hospitals were recommended development of integrated strategies, the “National Program
for prevention and control of NCD[28] but very little emphasis for Prevention and Control of Diabetes, Cardiovascular diseases
was given to improve and upgrade of knowledge and skills of and Stroke” was launched as pilot in 10 districts of 10 states
primary health care providers. on January 4, 2008. The objectives of the program are risk
reduction for prevention of NCDs and early diagnosis and
Diabetes Education in Indian Guidelines for appropriate management of diabetes, cardiovascular diseases,
Management of Type 2 Diabetes Mellitus and stroke via health promotion for the general population and
disease prevention for the high‑risk groups. Now, the program
India’s first guideline for the management of type  2 diabetes has been expanded to include cancer and is being implemented
mellitus was developed as a result of the national workshop on across all the states in the country and operational guidelines for
guidelines for management of type 2 diabetes mellitus conducted implementation of the program are in place.[32]
by the Indian Council of Medical Research (ICMR) and the
World Health Organization (WHO) in Chennai in May 2003. Diabetes Education in Medical Education
The objectives behind the development of these guidelines
were to establish a standard diagnostic criterion for diabetes, In India, the first medical institution named Medical College,
glucose intolerance and gestational diabetes, self‑monitoring Bengal was established by the British East India Company in
and annual follow‑ups, screening of asymptomatic and high‑risk 1835 at Kolkata with an annual intake of 49 students. Currently,
individuals, various treatment modalities including diet and the numbers have increased to nearly 83000 students and there are
lifestyle modification, medical interventions, and early detection 554 medical colleges including both government and private all
of complications with appropriate measures to arrest and reverse across the country.[33] Very little attention is paid to endocrinology
them. Emphasis was given on diabetes education for people or diabetology during their undergraduate study.[34] More focused
living with diabetes which, by definition means empowering and specialized post‑graduate courses are providing a more
people with diabetes with knowledge and providing tools crucial detailed description of endocrinology, including diabetes, but
for making them an active partner in the diabetes management the intake/seats are very limited. These courses include MD
team[29], but the guidelines did not address strategies to train and medicine, DM endocrinology, Diploma in diabetology[33], and
build the capacity of PCPs and general practitioners who bear DNB endocrinology/general medicine.[35] The specialization‑wise
the majority of the burden of diabetes management in India. colleges and seat distribution are shown in Table 1.
As a result, the need for proper strategies for evolution and
implementation of national guidelines on diabetes and related Diabetes Capacity‑Building Programs in India
disorders was felt by several researchers.[30] In recent years,
various Indian scientific bodies and diabetes research groups In the last ten years, few public and private institutions have
have developed diabetes treatment guidelines and clinical practice developed diabetes education and training programs for PCPs
recommendations for better patient outcomes but these too are independently or in collaboration with other like‑minded
clinically oriented. institutions. These programs include 16 fellowships [Table 2],
4 diplomas [Table 3], 12 certificate programs  [Table 4], and
Diabetes Education in National Programs 6 other diabetes training programs [Table 5]. These programs
are meant for medical graduates only. The mode of delivery of
The “National Diabetes Control Program” was launched during these programs varies from institution to institution; some are
the seventh five‑year plan in 1987 in some districts of Tamil full‑time, while others are offered through different modes such
Nadu, J and K, and Karnataka. The main thrust during the as regular, distance, online, and contact session‑based.

Journal of Family Medicine and Primary Care 841 Volume 11 : Issue 3 : March 2022
Mehra, et al.: Emergence of diabetes education India

Discussion ratio in India is less than the WHO‑prescribed limit where each
government allopathic doctor serves 11000 people.[66] In such
Considering the chronic nature of noncommunicable diseases a situation, it becomes very difficult for the physicians to give
and similar prevention strategies, primary healthcare continues proper care and counseling about lifestyle, diet, physical activity,
to be the cornerstone in the prevention and management of health communication, and other methods of prevention to the
diabetes.[64] However, most physicians are unable in providing patients and their caretakers for better disease management.[17]
evidence‑based care because of inadequate attention to diabetes Hence, capacity building of primary care physicians becomes
during their undergraduate programs and they need to invest imperative to halt the rising burden of diabetes.
almost 11.5 years to become a specialist of the subject.[34] The
majority of these specialists are concentrated in urban areas or Recognizing these issues and challenges, few organizations/
metro cities. Estimates from studies indicate that there are about institutes both government and private started diabetes education
four times as many allopathic doctors per 10,000 population in and capacity‑building programs for PCPs in India. These pioneer
urban areas as compared to rural areas.[65] Thus PCPs become initiatives need to be encouraged and appreciated. Most of
the key care providers for patients suffering from diabetes in the these programs are full‑time and consist of regular fellowships
country especially in rural areas. or diplomas in diabetes. Such programs provide deep insights
toward the subject and practical exposure, but one has to leave
It is evident that tight glycemic control and early initiation of his/her clinical practice to receive the benefit and to get enrolled
insulin can delay the onset of diabetes‑related complications; yet, in these programs. Additionally, the number of institutions as
PCPs delay insulin initiation due to poor or limited knowledge well as the annual intake capacity of these programs is very low.
about insulin therapy.[14] Furthermore, the doctor‑to‑patient
Some of these organizations offer online capacity‑building
Table 1: Medical colleges and seat distribution programs. These online programs either adopt prerecorded
Degree No. of colleges Annual intake lectures or live streaming of the sessions as teaching methodology.
MBBS 554 82950 Online courses can result in greater educational opportunities but
MD general medicine 333 4076 require a certain level of human and infrastructural resources.[67]
DNB general medicine 254 674 In a country like India, the online mode of education has its own
DM endocrinology 32 102 limitations because of poor Internet connectivity, limited access
DNB endocrinology 10 19 to digital media, and electricity cuts in rural and remote areas.
Diploma in diabetology 2 4
Moreover, online sessions are time‑bound and there is little scope

Table 2: Fellowship programs in diabetes


Institute Course name Eligibility Mode Duration
M V Hospital for Diabetes and The Tamil Nadu Post Doc Fellowship in Diabetology MD/DNB Full time 1 year
Dr. MGR University[36]
M V Hospital for Diabetes and The Tamil Nadu Post Doc Fellowship in Podiatry MS Full time 1 year
Dr. MGR University[36]
M V Hospital for Diabetes and The Tamil Nadu Post Graduate Fellowship in Medical Science MBBS Full time 2 year
Dr. MGR University[36] (Clinical Diabetology)
Dr. Mohan’s Diabetes Education Academy & The Post‑Doctoral Fellowship in Diabetology MD/DNB Full time 1 year
Tamil Nadu Dr. MGR Medical University[37]
Dr. Mohan’s Diabetes Education Academy[37] Fellowship in Diabetology MBBS Full time 2 years
Dr. Mohan’s Diabetes Education Academy[37] Fellowship in Eye Disorder of Diabetes MBBS with PG Full time 1 year
Ophthalmology
Dr. A. Ramachandran’s Diabetes Hospitals & The Fellowship in clinical diabetology MBBS Full time 2 year
Tamil Nadu Dr. MGR Medical University[38]
CMC Vellore[39] Distance Fellowship in Diabetes Management MD/DNB Distance 1 year
CMC Vellore[40] Post Doc Fellowship in Diabetology MD/DNB Full time 1 year
CMC Vellore[40] Post graduate Fellowship in diabetes MBBS Full time 2 year
Maharashtra University of health sciences, Nasik[41] Fellowship Course in Diabetology MD Full time 1 year
Kanungo Institute of Diabetes Specialities[42] Fellowship in Diabetology MBBS Full time 1 year
Dr. Mayur Patel Swasthya Diabetes Care, All Fellowship in Diabetology MBBS Full time 2 years
India Institute of Diabetes and Research & Yash
Diabetes Specialities Center[43]
Apollo & MeDvarsity[44] Fellowship in Diabetes Mellitus MBBS Online 1 year
Indian Medical Association ‑ TNSB[45] Fellowship certification in diabetology MBBS Contact classes and 1 year
hands‑on experience
Indian Medical Association ‑ CGP[46] Fellowship in Diabetes Mellitus MBBS Online 1 year

Journal of Family Medicine and Primary Care 842 Volume 11 : Issue 3 : March 2022
Mehra, et al.: Emergence of diabetes education India

Table 3: Diploma programs in diabetes


Institute Course name Eligibility Mode Duration
Madras Medical College[47] Diploma in Diabetology MBBS Full time 2 years
Topiwala National Medical College & B. Y. L. Diploma in Diabetology MBBS Full time 2 years
Nair Charitable Hospital, Mumbai[48]
The Tamilnadu Dr. MGR Medical University[49] Post Doc Diploma in Diabetology MD Full time 1 year
Apollo & MeDvarsity[44] Diploma in Diabetes Management MBBD or MD Online 6 months

Table 4: Certificate programs in diabetes


Institute Course name Eligibility Mode Duration
BMJ/Royal College of Physicians/Fortis Certification course in diabetes MBBS Online 6 months
C‑DOC[50]
PHFI/DMDEA[51] Certificate course in evidence‑based diabetes MBBS Online Contact 1 year
management sessions
PHFI/DMDEA[52] Certificate course in gestational diabetes mellitus MBBS Online Contact 4 months
sessions
PHFI/DMDEA/Arvind Eye Care Certificate course in evidence management of MBBS Online 4 months
System[53] diabetic retinopathy sessions
PHFI/CDI[54] Advanced certificate course in prevention and MBBS Online Contact 6 months
management of diabetes and cardiovascular disease sessions
Indian Academy of Diabetes & Boolean Certificate Course in Diabetes Management MBBS Online 4 months
Education[55]
Apollo & MeDvarsity[44] Certificate in diabetes management MBBS Online 3 months
RSSDI[56] Certificate Course in diabetology MBBS/MD Full time 1 year for MD and
2 years for MBBS
IMA AKN Sinha Institute[57] Post Graduate Certificate Course in Clinical MBBS Distance 6 months to 2 years
Diabetes
Nizam institute of Medical Sciences and Post Graduate Certificate of Competences in MBBS Online
WHO Collaborating Center for Diabetes Diabetology/WebCME
in Developing Countries[58]
Cleveland Clinic[59] Advanced Certificate Course in Diabetes MBBS Regular 2 days
Kokilaben Dhirubhai Ambani Hospital[60] Certificate Course in Diabetology MBBS Regular 1 year

Table 5: Other diabetes training programs


Institute Course name Eligibility Mode Duration
Coimbatore Diabetes Foundation & ADA[61] Clinical diabetology course & training Program MBBS Contact sessions 6 months
Nizam institute of Medical Sciences[56] P G Course in Diabetes MBBS 1 year
CMC Vellore[40] Short course for doctors in Diabetes Mellitus MBBS Regular 6 days
The Tamilnadu Dr. MGR Medical University[49] Refresher course in Diabetology MBBS Distance 6 months
University of South Wales, UK[62] Post Graduate Diploma in Diabetes MBBS Online 6 weeks
Cardiff University[63] Postgraduate Diabetes Diploma MBBS Online 2 years

for participants to clarify their doubts and discuss their queries leading world‑renowned academic partners like Dr. Mohan’s
with the tutor/faculty alongside their clinical responsibilities. Diabetes Education Academy (DMDEA).[68]

Considering the busy schedule of practicing doctors and Another issue with these programs is recognition or affiliation
following the guru‑shishya system of education, few organizations from councils or universities. The Medical Council of India
developed contact‑based capacity‑building programs. PCPs can accredits all the courses offered in medical colleges. Most of the
continue their clinical practices and attend the contact sessions fellowships and diplomas, no matter how extensive and efficient
at their nearest center on the day of the contact session. During the curriculum and modality is, have not received recognition
the contact session, enrolled participants get the opportunity or affiliation of medical councils or universities which needs
to interact with the faculty and discuss their doubts about to be addressed as this is a long‑felt need in the community. As
specific situations. Similarly, the Public Health Foundation none of the online and contact session‑based capacity‑building
of India (PHFI) has developed the capacity of more than programs are accredited, this raises the question on the quality of
15000 primary care physician with its various diabetes‑related their program delivery. Participating physicians are also looking
capacity‑building programs since 2010 in collaboration with for some recognition or affiliation while entering into these

Journal of Family Medicine and Primary Care 843 Volume 11 : Issue 3 : March 2022
Mehra, et al.: Emergence of diabetes education India

programs and often misuse the training received and claimed can be sustained for a long time. The learning from these training
they are specialized. programs can be used in the development and implementation
of similar programs in other low‑ and middle‑income countries
According to the DAWN2 study, healthcare professionals that face an alarming burden of noncommunicable diseases and
strongly feel that the curriculum at the graduation level is not a shortage of trained physicians.
adequate to build the capacity of these medical graduates to
efficiently manage diabetes at the community level. It is evident A major target of the WHO global action plan for prevention
that these short‑term capacity‑building programs are effective and control of noncommunicable diseases is to “halt the rise
in improving the knowledge and skills of PCPs in diabetes in diabetes and obesity.” To achieve this, several measures to
management.[69,70] So, these capacity‑building initiatives can play a strengthen primary care are imperative. We believe that the
major role in building the capacity and skills of newly graduated comprehensive list of diabetes education and capacity‑building
professionals for better patient outcomes. These initiatives have programs in this article will help PCPs in accessing the
high potential for scaling up while optimally addressing the appropriate program and thereby enhancing their knowledge
scarcity of trained mental health professionals in high population and skills for better diabetes management and patient outcome in
density settings like India. These can prove to be a sustainable resource‑limited countries.
model while strengthening the linkages between community and
existing government programs. Key Messages
As medical science is changing rapidly, PCPs need to upgrade
Apart from this, the Indian health system is currently more their skills and knowledge regularly to manage NCDs such as
designed to tackle communicable diseases and maternal and diabetes more effectively and efficiently. The comprehensive list
child health issues. However, due to rapid epidemiological of diabetes education and capacity‑building programs in this
transition, the disease burden has shifted from communicable article will help PCPs in accessing the appropriate program as per
to noncommunicable diseases. Building the capacity of PCPs in their need. The article will also help academicians, researchers
NCD prevention and control along with community awareness and policymakers to access the comprehensive information on
generation programs is the need of an hour to manage lifelong the educational programs launched so far in the field of diabetes
diseases like diabetes. Therefore, it is necessary to shift the focus and endocrinology in the country. This will further help in
of health planning, policies and programs in India and then modifiying and develop the necessary training programs for the
keep it to achieve the Sustainable Development Goal target 3.4, healthcare workforce in the respective field in future.
which calls for reducing premature death from NCDs, including
diabetes, by 30% by 2030.[71] Financial support and sponsorship
Nil.
Conclusion
As medical science is changing very rapidly, medical professionals Conflicts of interest
need to upgrade their skills and knowledge regularly to manage There are no conflicts of interest.
diseases in more effective and efficient ways. This can be possible
only if scientific and evidence‑based capacity‑building programs References
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Journal of Family Medicine and Primary Care 846 Volume 11 : Issue 3 : March 2022

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